I.1 Oral Contraceptives

Front 1

Distinguish between COCs and POPs

Back 1

1. COCs: combined oral contraceptives
-contain both esterogen and progestin.
-Classified fixed, phasic or extended dose
-synthetic hormones are better than natural because the are predictable and have greater potency

2. POPs: progestin-only pills
-estrogen free with continuous flow of low dose progestin
-indicated for women who should not take estrogen-containing pills
-slightly less effective than COCs and more liikely to cause irregular menstrual patterns

Front 2

Identify the types of synthetic estrogens and progesterones found in oral contraceptives
and the max dose

Back 2

2 types found in COCs:

1. Mestonol: breaks down into EE in the body
2. Ethinul estradiol (EE): almost all COCs have this

Most formulations contain 20-25mg, should not give more than 35mg (will produce more side effects)

Front 3

identify the types of progesterones found in oral contraceptives

Back 3

7 types used in COCs: (EL3N2D)

1. Ethynodiol diacetate
2 .Levonorgestrel
3.Norethindrone/Norethinedrone Acetate (also used in POPs)
4. Norgestrel
5. Norgestimate
6. Desogestrel
7. Drospirenone (has mineralocorticoid properties [structually realted to spironolactone-k sparring diuretic])

Front 4

Explain the clinical significance of the amt and type of steroid found in oral contraceptives.

Back 4

The type of progestin will determine the potency and adrogenic activity.
The dosage will determine the potential side effects

Front 5

The the progestin hormone according to their potency and androgenic activity.

Back 5

Progestin activity:
1. Most potent: desogesterl, levonorgestrel, norgestrel
2. Least potent: norethindrone

Androgenic activity:
1. Most: norgesterl
2. Intermediate: norethinedrone, ethynodiol
3. Least: desogestrel, norgestimate

Front 6

List the most common side effects and the dosage most likely to produce them.

Back 6

1. Nausea, breast tenderness, increased BP, melasma, headache = TOO MUCH ESTROGEN
2. Early or mid-cycle breatkthrough bleeding, increased spotting, hypomenorrhea = TOO LITTLE ESTROGEN
3. Breast tenderness, HA, fatigue, changes in mood = TOO MUCH PROGESTIN
4. Late breakthrough bledding = TOO MUCH PROGESTIN
5. increased appetie, weight gain, acne, oily skin, hirsutism, increased LDL cholesterol, decreased HDL cholesterol = TOO MUCH ANDROGEN

Front 7

Summarize the efficacy of COCs and POPs when used perfectly or typically.

Back 7

1. COCs:
-perfect use have a failure rate of 0.1% in the 1st yr.

2. POPs:
-perfect use have failure rate 0.5% in the 1st year

3. Both COCs + POPs
- perfect use failure rate 3%
- typical use failure rate 8%

Front 8

Distinguish between various methods for initiating hormonal contraception.

Back 8

1. Office visits between menses: "Quick Start Method"
- BCP may be started at any point in the menstrual cycle. Taking the 1st pill immediately after requesting BCP enhances continuation rates.
- Also BCP may be started w/out a recent pap smear; this doesn't increase the risk of cervical neoplasia.

2. Postpartum: do not use COCs but can use POPs and IUD.

3. Lactation: WHO says no to hormonal BCP until 6wks after postpartum. PPRA says POPs can be used any time after postpartum.

4. Post-abortion: can start hormonal contraception immediately after.